Navigating the Facial Landscape: Topographic Mapping of Soft Tissue Thickness and Fat Compartments

Author: Kaavian Shariati

Area of Concentration: Basic, Clinical, and Translational Research

Specialty: Plastic and Reconstructive Surgery

Keywords: Facial soft tissue thickness, fat grafting

Background:
Sexual dimorphism in craniofacial skeletal anatomy is well documented, but differences in facial soft tissue structure have been assessed primarily through qualitative or superficial anthropometric analyses. As a result, guidelines for soft tissue intervention often lack the precision and dimensionality seen in osseous reconstruction. Advances in imaging have enabled quantification of subsurface soft tissue parameters, including facial soft tissue thickness (FSTT), yet these data are seldom directly implemented in clinical aesthetic or reconstructive planning. This study addresses this gap by analyzing FSTT variation across sex, ethnicity, BMI, and age, integrating results with fat pad anatomy to guide personalized grafting strategies.

Objective:
To evaluate demographic variation in FSTT and assess its alignment with superficial and deep fat compartments for use in targeted fat grafting.

Methods:
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed and Web of Science were searched for in vivo imaging studies in adults with sex and ethnicity reported. FSTT values at 31 standardized landmarks were extracted, grouped into nine regions, and aligned with 14 facial fat compartments. Statistical analyses included unpaired t-tests with Welch correction and multiple linear regression models.

Results:
Thirty-three studies (n=6,530; 3,303 males, 3,227 females) were included. Males had greater FSTT at most midline regions, while females had greater thickness in zygomatic and infraorbital areas. Increasing age and BMI mitigated significant dimorphism. Ethnic groups exhibited distinct patterns. Females had thicker deep fat pad regions; males had thicker superficial regions. Age-stratified models revealed significant FSTT variation in female deep fat pad regions only.

Conclusions:
This review presents the largest in vivo FSTT dataset to date. Findings support sex-specific, regionally tailored fat grafting approaches, with deep pads suited for structural reshaping and superficial pads for contouring. Further research is needed to validate fat pad dynamics in aging.